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Purpose <p>Severe COVID-19 may have lasting effects on physical and sleep behaviors, which could affect health-related quality of life (HRQoL). This study aimed to assess 2-year trajectories of device-assessed physical and sleep behaviors post-hospitalization, comparing ICU- and non-ICU-treated patients, and to assess their association with HRQoL.</p> Methods <p>7-day wrist-worn accelerometer assessment at 3–6, 12, and 24 months post-hospitalization. Physical behavior: physical activity volume, time spent in light (LIPA) and moderate-to-vigorous (MVPA) physical activity, and inactivity; sleep behavior: sleep duration, efficiency, and sleep regularity index (SRI); HRQoL: EQ-5D-5L questionnaire. Multivariable generalized estimating equations models were used to assess trajectories, and associations of physical activity (LIPA, MVPA) and sleep duration with HRQoL adjusted for covariables.</p> Results <p>358 patients (mean age 59.7 ± 10.5 years, 246 [69%] males, 137 [38%] ICU-treated) were included. In the total cohort, estimated mean physical activity volume was 23.5 mg/day (SE 0.40), with 153.2 min (SE 2.6) LIPA, 32.7 min (SE 1.4) MVPA, and 10.8 h (SE 0.07) inactive at 3–6 months. The estimated mean sleep duration was 6.9 (SE 0.05) hours/night, efficiency 71.1% (SE 0.41), and SRI 52.7% (SE 0.72). ICU-treated patients showed significantly lower physical activity volume (22.6 [SE 0.55] vs. 24.2 [SE 0.54], <i>p</i> = 0.05) and SRI (50.3 [SE 1.2] vs. 53.2 [SE 0.95], <i>p</i> = 0.04) compared to non-ICU-treated patients. Over time, physical and sleep outcomes remained stable in the total cohort. However, ICU-treated patients showed greater improvements in physical activity between 3–6 months and 1 year compared to non-ICU-treated patients (e.g., mean difference in change in MVPA = 6.9 min [95% CI 2.0 to 11.8], <i>p</i> = 0.006). Trajectories did not differ significantly between groups thereafter. MVPA, but not LIPA and sleep duration, was significantly associated with HRQoL, independent of covariables (β<sub>adjusted</sub> 0.06 [95% CI 0.02 to 0.10], <i>p</i> = 0.004).</p> Conclusion <p>Device-assessed physical and sleep behaviors seemed generally sufficient and remained stable up to 2 years post-hospitalization. However, ICU-treated patients initially showed less physical activity, reaching the levels of non-ICU-treated from the 1-year visit onwards, likely reflecting recovery from critical illness. Less time spent in MVPA was associated with poorer HRQoL; however, physical activity support should be personalized and cautiously considered in COVID-19 aftercare.</p> Trial registration <p>This study has been prospectively registered in the International Clinical Trial Registry Platform (NL8710).</p>

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Trajectories of device-assessed physical activity and sleep in ICU- and non-ICU-treated patients up to 2 years after hospitalization for COVID-19, and their association with health-related quality of life

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  • 发表日期：

    2025年11月28日

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  • J. C. Berentschot,
  • G. W. M. Broeren,
  • L. M. Bek,
  • M. E. Hellemons,
  • J. van Bommel,
  • J. G. J. V. Aerts,
  • G. M. Ribbers,
  • J. B. J. Bussmann,
  • M. H. Heijenbrok-Kal,
  • H. J. G. van den Berg-Emons,
  • Joachim G. J. V. Aerts,
  • L. Martine Bek,
  • Julia C. Berentschot,
  • Rita J. G. van den Berg-Emons,
  • Sieshem Bindraban,
  • Wouter J. B. Blox,
  • Jasper van Bommel,
  • Shai A. Gajadin,
  • Michel E. van Genderen,
  • Diederik A. M. P. J. Gommers,
  • Majanka H. Heijenbrok-Kal,
  • Merel E. Hellemons,
  • Roxane Heller,
  • Erwin Ista,
  • Stephanie van Loon-Kooij,
  • Chantal Luijkx,
  • Rutger Osterthun,
  • Laurien Oswald,
  • Gerard M. Ribbers,
  • Ronald N. van Rossem,
  • Herbert J. van de Sande,
  • Robert van der Stoep,
  • Janette J. Tazmi-Staal,
  • Markus P. J. M. Wijffels,
  • Eva G. Willems

摘要

Purpose

Severe COVID-19 may have lasting effects on physical and sleep behaviors, which could affect health-related quality of life (HRQoL). This study aimed to assess 2-year trajectories of device-assessed physical and sleep behaviors post-hospitalization, comparing ICU- and non-ICU-treated patients, and to assess their association with HRQoL.

Methods

7-day wrist-worn accelerometer assessment at 3–6, 12, and 24 months post-hospitalization. Physical behavior: physical activity volume, time spent in light (LIPA) and moderate-to-vigorous (MVPA) physical activity, and inactivity; sleep behavior: sleep duration, efficiency, and sleep regularity index (SRI); HRQoL: EQ-5D-5L questionnaire. Multivariable generalized estimating equations models were used to assess trajectories, and associations of physical activity (LIPA, MVPA) and sleep duration with HRQoL adjusted for covariables.

Results

358 patients (mean age 59.7 ± 10.5 years, 246 [69%] males, 137 [38%] ICU-treated) were included. In the total cohort, estimated mean physical activity volume was 23.5 mg/day (SE 0.40), with 153.2 min (SE 2.6) LIPA, 32.7 min (SE 1.4) MVPA, and 10.8 h (SE 0.07) inactive at 3–6 months. The estimated mean sleep duration was 6.9 (SE 0.05) hours/night, efficiency 71.1% (SE 0.41), and SRI 52.7% (SE 0.72). ICU-treated patients showed significantly lower physical activity volume (22.6 [SE 0.55] vs. 24.2 [SE 0.54], p = 0.05) and SRI (50.3 [SE 1.2] vs. 53.2 [SE 0.95], p = 0.04) compared to non-ICU-treated patients. Over time, physical and sleep outcomes remained stable in the total cohort. However, ICU-treated patients showed greater improvements in physical activity between 3–6 months and 1 year compared to non-ICU-treated patients (e.g., mean difference in change in MVPA = 6.9 min [95% CI 2.0 to 11.8], p = 0.006). Trajectories did not differ significantly between groups thereafter. MVPA, but not LIPA and sleep duration, was significantly associated with HRQoL, independent of covariables (βadjusted 0.06 [95% CI 0.02 to 0.10], p = 0.004).

Conclusion

Device-assessed physical and sleep behaviors seemed generally sufficient and remained stable up to 2 years post-hospitalization. However, ICU-treated patients initially showed less physical activity, reaching the levels of non-ICU-treated from the 1-year visit onwards, likely reflecting recovery from critical illness. Less time spent in MVPA was associated with poorer HRQoL; however, physical activity support should be personalized and cautiously considered in COVID-19 aftercare.

Trial registration

This study has been prospectively registered in the International Clinical Trial Registry Platform (NL8710).